Understanding Open Enrollment and Special Enrollment
Open Enrollment Period
This is the yearly period from November 1 to January 15 during which you can buy health insurance through the Marketplace or make changes to your existing health plan. If you don’t enroll during this time, you can’t purchase a health plan until the next Open Enrollment Period — unless you qualify for a Special Enrollment Period.
Special Enrollment Period
A Special Enrollment Period takes place outside the yearly Open Enrollment Period. You can enroll in a health plan through the Marketplace during a Special Enrollment Period only if you experience a Qualifying Life Event.
To be eligible for Virginia's Insurance Marketplace coverage, individuals / households must:
- Reside in Virginia.
- Be U.S. citizens, U.S. nationals, or lawfully present immigrants for the entire time they plan to have coverage.
- Not be incarcerated (unless pending disposition of charges).
- Be uninsured, generally not eligible for Medicaid or Medicare, and not have an offer of affordable employer-based coverage.
Qualifying Life Events
Certain changes in your circumstances are known as “Qualifying Life Events.” They include, but are not limited to:
- Getting married or divorced.
- Having a baby or adopting a child.
- Experiencing the death of the insurer in the family.
- Losing health insurance coverage due to job loss.
- Losing eligibility for Medicare, Medicaid, or Children’s Health Insurance Program (CHIP).
- Turning 26 and losing coverage from a parent’s health insurance plan.
- Moving to a different ZIP code or county or moving to the U.S. from a foreign country or U.S. territory.
After you experience a Qualifying Life Event, you usually have up to 60 days to make changes to your health insurance plan or enroll in a new plan through the Marketplace. When you enroll, have your personal information on hand in case Marketplace customer service representatives need to verify how the life event affects your health insurance coverage.
If you have lost Medicaid coverage between March 31, 2023 and December 31, 2024, you may be eligible to enroll in a Marketplace plan through a Special Enrollment Period (SEP). The SEP is available until December 31, 2024. Once a consumer begins an application, they have 90 days from that date to enroll in coverage and pay their first month’s premium.
How to Enroll
This video shows how easy it is for individuals and families to enroll in a new health plan. Virginians who are uninsured, are self-employed, or have jobs that don’t provide affordable insurance options can use the Marketplace to enroll in a health plan. Individual and family plans are available to those who don’t have access to affordable health coverage. Marketplace consumers may also qualify for financial assistance.
Enrolling in a Health Plan is Simple
Virginia’s Insurance Marketplace lets you shop for, compare, and purchase affordable, high-quality health insurance plans with comprehensive coverage. Plus, nearly 9 out of 10 customers qualify for financial savings.
Steps To Enroll
Most health plans must cover minimum essential benefits required by law and include preventive services — like vaccines and screening tests — at no cost to you. All Marketplace plans cover mental health and substance abuse services as essential health benefits and must cover treatment for preexisting medical conditions. You can pick a health plan with or without dental benefits. If you pick a health plan without dental benefits, you can still get a separate dental plan. Get started by clicking "Get Covered" and enroll with the steps below.
1. Shop, compare plans, and get a quote.
Select "Browse for health & dental plans". The Marketplace makes it easy for you to choose the type of coverage you need. You can filter your results, compare costs, and select the plan that works for you.
2. Gather your information.
To apply for your selected plan, make sure you have the following materials for each adult who will be covered:
- Photo ID.
- Social Security number.
- Most recent tax return.
- Pay stubs from the last four weeks.
- Immigration documents, if applicable.
3. Select your plan and enroll.
4. Pay your first month's premium.
To begin your coverage, you must make your first monthly payment (called the “premium”). Making payments is easy — plus, the Marketplace has options for applying for financial assistance.
You're covered!
Begin using your health insurance and get the care you need.
Virginia Medicaid/FAMIS
The Marketplace will also check eligibility for low-cost or no-cost health coverage programs through Virginia Medicaid or Family Access to Medical Insurance Security (FAMIS is Virginia’s health insurance program for children). For additional information about Medicaid coverage in Virginia, you can visit Cover Virginia or call 1-833-522-5582.
Helpful Resources:
- Consider these questions when choosing a plan.
- Download the Marketplace enrollment checklist.
- Visit the Marketplace Help Center to get contact information for assistance over the phone or in person.
- Follow the links to see plans offering health and dental coverage for 2024.
- Free Translation Services are available. Call the Consumer Assistance Center at 1-888-687-1501 for assistance.
Find a Virginia Certified Assister
Assisters in your community can help with every step of the application and enrollment process. They provide free, unbiased enrollment assistance, with options to meet virtually or in person.
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Call Customer Service
Contact the Marketplace’s customer service representatives if you need assistance enrolling in a health plan, need to update your personal information, or have any questions.
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Whether you’re shopping as an individual, family, or small business with employees, a Virginia Licensed Insurance Agent can provide you with free personalized plan recommendations and enrollment support.
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